Aetna Utilization Mangagement Nurse Consultant in Sunrise, Florida

Req ID: 42814BR

POSITION SUMMARY

The work setting is a fast paced environment where the nurse will be conducting UM onsite reviews and SNF, Rehab and LTACH admissions at a Broward County hospital system.

Fundamental Components:

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

BACKGROUND/EXPERIENCE desired:

Florida State Registered Nursing License Required

3-5 years of clinical experience required

Managed Care experience preferred

Concurrent Review/Discharge Planning experience preferred

Milliman Care Guidelines experience preferred

EDUCATION

The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/4-6 Years

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

DESIRED SKILLS

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

This will be an onsite position in Broward County Florida for a large hospital system.

ADDITIONAL JOB INFORMATION

Onsite position in Broward County Florida

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care